Giant Prostatic Calculi: A Novel Use of the Ultrasonic Lithoclast

Abstract

Introduction: A 51-year-old man with neurogenic bladder secondary to spina bifida had been managed with clean intermittent catheterization (CIC) his entire life. The patient subacutely developed difficulty performing CIC for several months, so a suprapubic tube was placed. Computed tomography scan obtained during a hospitalization for urosepsis revealed large stones in the prostatic urethra eroding into his prostate circumferentially. These stones were obstructing entrance of catheters into his bladder. Given his history of urosepsis and desire to resume CIC, the patient was taken to the operating room for attempted endoscopic treatment of these stones. Materials and Methods: Given the large stone burden and challenging location unsuitable for an Ellik evacuator, the stones were treated using ultrasonic lithotripsy rather than laser lithotripsy. The rigid nephroscope was blindly advanced to the bulbar urethra using the obturator. Ultrasonic lithotripsy and evacuation was then performed under direct observation using the Boston Scientific Swiss Lithoclast Select™. Results: All stones were cleared. The patient was admitted overnight for observation and discharged in the morning with his Foley catheter in place. There were no postoperative complications or readmissions. At 4 weeks, his Foley catheter was removed. He was still unable to perform CIC secondary to the large prostatic cavity that remained. The patient will undergo transurethral resection of the prostate to create more continuous anatomy through which catheters can traverse without the aid of a wire or direct observation. Another option offered but declined was creation of a continent catheterizable stoma. Conclusions: Ultrasonic lithotripsy is feasible for use in the prostatic urethra. In this case, it facilitated complete and efficient treatment of large prostatic urethral stone burden that would have otherwise required a more invasive procedure, such as simple prostatectomy. It is important to keep this equipment in the urologist's armamentarium for use in this nontraditional clinical scenario. No competing financial interests exist. Runtime of video: 4 mins 10 secs Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Music: This music (Clair de Lune by Debussy) was obtained from YouTube and is not copyrighted material.